{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ROSALIN RODRIGUEZ","gend":1,"add":"2402 HOMEVIEW DR APT D","city":"HENRICO","state":"VA","zip":"23294-9998","dob":"1986-02-26","age":"","mstatus":"","insh":"1238472*01","cliId":"","pno":"434\/228-6190","cno":"434\/228-6190","email":"","ename":"","eno":"","pphy":"ITSKOVICH, ROZANA A MD","ppno":"804\/364-8802","pcpadd":"STE 204 7660 E PARHAM RD","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":23294,"pcpcounty":"","pcpid":114392,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/362-1288","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["T22.211A","R68.84","K08.89","F10.20","F14.20","F15.20","F33.2","F41.1","F43.10","K04.7","F32.9","F41.9","T22.011A"],"date":["2020-04-05","2020-09-26","2020-09-26","2020-01-01","2020-01-01","2020-01-01","2020-01-01","2020-01-01","2020-01-01","2020-09-26","2020-09-26","2020-09-26","2020-04-05"],"priorHcc":["","","","","","","","","","","","",""]}},{"a":[]}]},{"t":"Covid Screening","q":[{"a":[]}]},{"t":"Self-Assessment and Social History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Activities of Daily Living","q":[{"a":[]}]},{"t":"Medical History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Family History","q":[{"a":[]}]},{"t":"Preventive Care","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","65162055310","METAXALONE ","800MG","15","Select","Select",""],["","47781060730","DISULFIRAM ","250MG","30","Select","Select",""],["","16729008110","NALTREXONE ","50MG","30","Select","Select",""],["","60505015701","BUPROPION ","100MG","30","Select","Select",""],["","00115165901","PROPRANOLOL ","10MG","60","Select","Select",""],["","68180012202","CEPHALEXIN ","500MG","20","Select","Select",""],["","67877012450","SILVER ","1%","50","Select","Select",""],["","59746000103","METHYLPRED ","4MG","21","Select","Select",""],["","51672401801","ETODOLAC ","400MG","20","Select","Select",""],["","00093310905","AMOXICILLIN ","500MG","11","Select","Select",""],["","42858010201","OXYCOD\/APAP ","5-325MG","12","Select","Select",""],["","62175061743","PANTOPRAZOLE ","40MG","30","Select","Select",""],["","47781060730","DISULFIRAM","250MG","30","Select","Select",""],["","16729008110","NALTREXONE","50MG","30","Select","Select",""],["","00115165901","PROPRANOLOL","10MG","60","Select","Select",""],["","60505015701","BUPROPION","100MG","30","Select","Select",""],["","59746000103","METHYLPRED","4MG","21","Select","Select",""],["","65162055310","METAXALONE","800MG","15","Select","Select",""],["","68180012202","CEPHALEXIN","500MG","20","Select","Select",""],["","67877012450","SILVER","1%","50","Select","Select",""],["","51672401801","ETODOLAC","400MG","20","Select","Select",""],["","00093310905","AMOXICILLIN","500MG","40","Select","Select",""],["","42858010201","OXYCOD\/APAP","5-325MG","12","Select","Select",""],["","62175061743","PANTOPRAZOLE","40MG","30","Select","Select",""],["","59746017306","PREDNISONE ","TAB 10MG","15","Select","Select",""],["","68180096301","ALBUTEROL ","AER HFA","8","Select","Select",""],["","00143924920","AMOX\/K ","TAB 875-125","14","Select","Select",""]]}},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Review of Systems and Diagnoses","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[[["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["No","Select","","","","","Select","",""]]]},{"t":"Mini-Cog","q":[{"a":[]}]},{"t":"Home Safety & Personal Goals","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Active Problem Conditions","q":[{"a":[]}]},{"t":"Patient Summary","q":[{"a1":"","a2":"","a3":"","a4":"","a5":"","a6":"","a7":[],"a8":"","a9":"","a10":[],"a11":"","a12":""}]}]}